671 Selva Lakes Cir 2013 paver patio .5% , .
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
07 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003669 Date 11/20/13
Property Address . . . . . . 671 SELVA LAKES CIR
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6251
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Application desc
paver patio in rear
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Owner Contractor
------------------------
------------------------
ROBERT, JOHN A OWNER
671 SELVA LAKES CIR
ATLANTIC BEACH FL 32233
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 85 . 00 Plan Check Fee 42 . 50
Issue Date . . . . Valuation . . . . 6251
Expiration Date . . 5/19/14
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 85 . 00 85 . 00 . 00 . 00
Plan Check Total 42 . 50 42 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 131 . 50 131 . 50 . 00 . 00
PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
P � 9 � 0 W �
CITY OF ATLANTIC BEACH Lig 1
800 Seminole Road, Atlantic Beach, FL 32233 NOV 3 2013
Office (904)247-5826 Fax (904) 247-5845
JobAddress: &31 SGLVA LAKe-5 Qikoke Permit N by
Legal Description Floor Area of S Ft. Parcel Sq Pt
Valuation of Work$(A�1.%'1 Proposed Work 'Oea- ted/cooled non-heated/cooled 14'45saic&
Class of Work(circle one): (Ee::w- Alteration Move Demolition pool/spa window/door
Addition Repair
Use of existing/proposed structure(s) circle one): Commercial &esidential)
If an existing structure,is a fire sprinMr system installed? (Circle one): Yes No /A)
Florida Product Approval#
For multiple products use product approval form
7
Describe in detail the type of work to be performed: jI.ALit�70- j)A1-a; k 7� J.
rii r Puy
I to- &- WWI I
Property Owner Information:
Name: ROAQLT +CA&()L�jPjt7_ _1014.0 Address: G 11 SELVA LAKC cl';t��
City Anp---nL dapco- State A_Zip_34a-�Phon�q o q) 96a, 14-1
E-Mail or Fax#(Optional) Pqoejt5P_T.
Contractor Information: CQ>�MACTQR EMAIL ADDRESS:
Company Name: Xr-
Qualifying Agent: fteAe-Ai_ L,�L4,.
Address. city State zi
Office Phon"e flo4i Vjr- o asq-7
Job , 04 (4 Fax
-1-:1=111=11:111 J
c iop r istrati
State Certif, at eg on JAEA r%,4 ri rr=9'
Architect Na P one A�t'h ;!0— ODEeop
Engineer's�Ke_�Pho e# CM Of*TLUMC MPtLVLN u
itle r
Fee Simple itle Holde am nd Address N BEACH
Bonding Company Name Address (�V'f 7;_-W PeRmm MIZ X,.UrrONAL
Mortgage Lender Name and Address W�!� "ClUIR ghdt&F.Ps AND MmmONS.
I REVIEWEDBY.
4pplication is hereby made to obtain a permit to do the work an
n
N�a'm' n d A
e Addres 4n
e T' ��77e�Ta"=-rc-m7�,7hat commencedprior to the
issuance cf a permit and that all work will be pe�jbrmed to meet th t5n taT , ![ -11 1 0 it becomes null
and void iTwork is not commenced within six(6)months, or if construction or work is suspended or abandone or a er =t any time after
work is commenced. I understand that separate permits must be securedfor Electrical Work,Plumbing, ns, S. oals, rnaces,Boilers, Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I;�hereb certify that I have read and exam i.ned this application and know the same to be true and correct. All provisions of laws and ordinances govern ing this
P, 07,vork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherjederal��sate, or local la regulating construction o, he performance of construction.
r
Signature of Ownerx�m�'�7 Z�'� Signature of Contractor
Print Name Print Name
A.8 .............
Befo!�W Before me
i of 1:21
t:h I /1 . 20 this Day of 20
G
Notary P
jV
Notary Public Q btuary 14,2014 ublic
. z -",P1Rr:S
-qg E ��t�ryPubllr;Underwr
sondadTh t
Tu Revised 01.26.10
CITY OF ATLANTIC BEACH
E Copy '
(OWNER / ]BUILDER AFFIDAVIT, L
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW-
DISCLOSURE STATEN4ENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERNUT UNDER AN EXEAPTION TO THAT
LAW. THE EXENIPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR MROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
EVIPROVE A CONEAERCL&L BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS CONIPLETE, THE LAW WILL PRESUNM THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TIES EXENIPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE ENDLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR NfUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENAL TY UNDER FLORIDA STATUTE NO.
455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
(Ah SO-LiA LA49K CLO-cL8
ADDRESS PHONE NUMBER
(SIGNATURE
Before me this /3day of V 20_L3 the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of )15�L_,County
El Personally Known L
t
D Produced Ident!
f
7NOLEY
M
957760
Notary Si ture: 14,20 t4
Wndm Tt
;" . I Unde,writels
F:/BLDG/O��-Bui�ld�Affada�i�t�Pj.---IVISED: 6/2009
NOTICE OF COMMENCEMEN FILE COPYA
(PREPARE IN DUPLICATE)
Permit No. -366
State of EL.,�, Tax Folio No.
CouWy of A�,l�j
To whom it may concern:
The undersigned hereby Informs you that improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: SELdA i -.AKC-,,s GaCLC- %j8,rj-,jL
�L--�V-0 (71,i,�L t so i,*,. -111 e A"Xv- V.v-,1)
Address of,property being improved: 611 ISL-'L�LA Liq kC-� C i Act,�- 11 ZL AN 11 L!3u-
General descript fion of improvements: AAVV�L 31DO ,4,A"
Owner IQO&-,OF IjDr�i3
Address C-)4-1 LL? 1-0/4 bAke-s C1QCL(-- 111JAN-.1L
Owner's interest in site of the improvement L-"�4�-L--
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
Address
Phone No. Fax No.
Surety(if any)
Address Amount of bond
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name ofperson within the State of Florida,other than himself,designated by owner uponwhorn notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to rece,�ve a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name !VQ.-Ji�
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date Is one(1)year from the date of recording unless a
different date Is speeffled):
THIS SPACE FOR RECORDEWS USE ONLY
OWNER
Signed: DATE
Before r�o this
_L-�__day of A?/Tj -&Ir?j in the
CalOf Duval.State of Florida,has personalty appeared
vpl:�Lk �2im44 -------tLere1 b SAN K.SUI
himset herselfand affirms that all statements and declarations her su -L'VA
Doc#2013290420,OR SK 16595 Page 909, are trucf!and aocurate Le of IV rid',
NotarY Public,St8l
Number Pages:1 My Comm.Expires Aug. 201
Recorded 1111 3i2013 at 02:14 PM,
K CIRCUIT COURT DUVAL Commission No.EE 10 100
Ronnie Fussell CLER
COUNTY cul
Rotary Publiu at Large,State of 11`�L- County of a�,LvAi-
RECORDING$10 00 My oommission expires: kA7 tL�, Z".15'
FersonaliyKnown or
Produred Identification P L- -J YX --7 t,-i -7o
SELVA LAKES CIRCLE
(o 0 , R1 kv.)
411 P.C.
-7
COPY
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S83-4-2- 00"W
THE P AZ A (80' R/W)
S&�V V4f
-A0 UA10A r16 W.. S&�Vycy 9 -9 7 DIRECTION MELI
THAT THIS SURVEY PERFORMFD UNDER my RESPONSIBLE I jr,17-0, FLC
I HEREBY CERTIFY �CCORDANCE YATH CHAPTER 13
AUM TECHNICAL STANDARDS FOR LAND SU�vEYORS IN A
mIN4 472.027, FLORIDA STATUTFS), AND FURTHER CERTIFY
ADMINISTRATIVE CODE (PURSUANT TO SECTION THE SUBjEcT PROPERTY EXCEPT AS SHO�M
-NTS UPON
T"FpF ARE NO VISIBLE ENCROACHMF DOD CLARSON AND ASSoC'A'V-
FLOOD CERWICATE, THE Lor sHOm HEREON is IN FU la43 MALDO AVE,, JACKSONWI-E, FL,
AS SHOYM ON THE FLOOD INSURANCE RATE
ZONE OOOID , E)ATED4-17-59-
MAP, COMMUNITY PANEL NO. izQO7!5 'r
SURvEYED �Eo SU�RV ��
SCALE: 1" = 20' 74 JoSE A. HILL
F-IFLI) BOOK_ 537 PAGF
5,50
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
o, Phone(904) 247-5826 - Fax(904)247-5845
- // A3//-F
E-mail: building-dept@coab.us Date routed.
Cityweb-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ell— D rtment review required Yes,-No
r
Applicant: Planning &Zoning
or
ftreerra or
Public Works
Project: Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review-: MA-pproved.. E]Denied.
(Circle one.) Comments:
(E�D:1N 6)
PLANNING&ZONING Reviewed by: Date:
=1�d
TREEADMIN. Second Review: FlApproved as revised. r ID ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RApproved as revised. DIDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach APPLICATION NUMBER
(To be assigned by the Building Department
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904) 247-5826 - Fax(904)247-5845 Late routed:
E-mail: building-dept@coab.us
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: el'z- D 4 * rtment review required Yes No
Planning &Zoning
Applicant: o L'�)-;r) r dAdIffiThMtCdtor
Public Works
Project: Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Re iew or Receipt Date
of Permit Verified By
F Florida Dept. of Environmental Protection
Florida Dept. of Transportation vLi—u;--- Yes
rtmenty revview requirledU7
rt_1_ r_to
eCAdm Mttta r
Review or Receipt
ther Ag en cy Review or Permit Required of P ermit Ve rified By
londa Dept of Envi ro nmental Protection
F lon da Dept of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLI ION STATUS
Reviewing Department First Review: pproved. E]Denied.
I'A 'ON STATU
F�__ Z ' _
pprov ed.
(Circle one.) Comments: f
IF f%�,p i) A 1�h er TjaA '30 cc(eq se— &Y;1�/<,P—
BUILDING <,A&dc ov 4��_ Date:
PLANNING &ZONING Reviewed by4: 40
TREE ADMIN. Second Review: FlApproved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RAPproved as revised. FIDenied-
Comments:
Reviewed by: Date:
Revised 07/27110